Measurement of Splenic Stiffness as a Predictor of Oesophageal Varices in Patients with Liver Cirrhosis in Zagazig University Hospitals

Abstract

Background and study aim: Portal hypertension (PH) is a frequent complication of cirrhosis, contributing to the development of ascites, esophageal varices (EV) and hepatic encephalopathy. The best available methodology for the assessment of PH is measurement of the hepatic vein pressure gradient (HVPG). However, the performance of HVPG is limited to highly specialized centers and requires extensive experience Predicting the presence, grading and follow up of esophageal varices by non-invasive means might increase compliance and would permit to restrict the performance of endoscopy to those patients with a high probability of having varices. Patients and Methods: This study included 117 individuals divided into two groups. Group I: included 39 normal individuals as a control group for splenic stiffness measurement. Group II: included 78 cirrhotic patients. All patients of group II were subjected to upper GIT endoscopy and according to the results this group was subdivided into patients with no varices (IIa) and patients with esophageal varices (IIb). All patients underwent clinical assessment, routine laboratory evaluation, BMI, splenic and liver stiffness measurement, upper GIT endoscopy. Splenic stiffness measurement repeated for patients who had varices after 6 months of pharmaco medical treatment. Results: Splenic stiffness was found to be higher in cirrhotic group than control group, splenic stiffness measurement was found to be higher in patients who had varices than no varices in cirrhotic patients, cut off of SSM for the presence of varices ≥39.5 kpa had AUROC 0.999, sensitivity 97.7%, specificity 96.9%, PPV 97.8% and NPV while LSM showed cut off value for presence of varices >22.5 kpa had AUROC 0.641 sensitivity 84.44%, specificity 60.61%, PPV 74.5% and NPV 74.1%. PSR showed cut of ≤657.7 had AUROC 0.855 sensitivity 95.56%, specificity 78.79%, PPV 86% and NPV 92.9%. APRI showed cut off >2.7 had AUROC 0.657 sensitivity 57.78, specificity 93.94%, PPV 92.9% and NPV 62%. There was highly significant difference in median SS in patients with large varices versus small varices (49.6vs 71.58 kpa with p<.0001).SSM is not a useful tool for follow up of varices after pharmacological treatment with non selective beta-blockers (p=0.014). Conclusion: Fibroscan is a sensitive and reliable method for detection of esophageal varices. Splenic stiffness showed the best performance on detection of eosophageal varices, when compared to other non invasive predictors, PSR came in the 2nd place. Splenic stiffness measurement can differentiate small and large varices